Effectiveness of tranexamic acid in reducing blood loss in spinal surgery: a meta-analysis

Abstract

BackgroundThe aim of present meta-analysis was to evaluate the effectiveness of tranexamic acid (TXA) use in reducing blood loss and the related thrombotic complications in spinal surgery.MethodsThree databases (MEDLINE, EMBASE, and the Cochrane Library) were searched through October 2012 to identify the relevant randomized controlled trials (RCTs) regarding the TXA effective in spinal surgery. Mean differences (MDs) of blood loss, blood transfusions, and postoperative partial thromboplastic time (PTT), odds ratios (ORs) of blood transfusion and thrombotic complication in TXA-treated group compared to placebo group were extracted and combined using random-effect meta-analysis.ResultsA total of 6 RCTs comprising 411 patients were included in the meta-analysis according to the pre-defined selection criteria. TXA-treated group had significantly less amount of blood loss and blood transfusions per patient, and had smaller proportion of patients who required a blood transfusion compared with the placebo group. The use of TXA can significantly reduce the postoperative PTT with weighted MD of -1.59 [(95% confidence interval (CI):-3.07, -0.10] There is a null association between thrombosis complications and the use of TXA.ConclusionWe conclude that the use of TXA in patients undergoing spinal surgery appears to be effective in reducing the amount of blood loss, the volume of blood transfusion, the transfusion rate, and the postoperative PTT. However, data were too limited for any conclusions regarding safety. More high-quality RCTs are required before recommending the administered of TXA in spinal surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-448) contains supplementary material, which is available to authorized users.

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

“…part to the less robust available body of TXA-spine literature. A metaanalysis by Li, et al examining six placebo controlled trials found no significant increase in risk of DVT, however other recent meta analyses have been less absolute in their conclusions about thromboembolic risk, citing a relatively small number of patients and investigations included within their scope of analysis that may be insufficient to make definitive claims on DVT and PE risk [37,45,46]. Future investigations with larger patient cohorts in the coming years will shed further light on the safety of TXA as a means to reduce blood loss in spinal surgery.…”

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

“…The drug was being used in off-label conditions because spine surgery was not one of the labelled indications 20 listed in the product insert. 26 27 More recent meta-analyses [28][29][30][31][32] suggested the need for additional studies with larger patient samples because of the considerable heterogeneity of available studies regarding the type of surgery, the drug dose and administration regimen used.…”

“…This rate seems much higher compared 55 with other studies. [29][30][31] Reasons contributing to this high rate of transfusion include surgeries with blood loss exceeding 37% of total blood volume and non-compliance with the study protocol as a result of the clinical condition of the patient requiring transfusion without prior Hb determination.…”

Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery

“…14 spinal cord or cauda equine compression [48]. Tranexamic acid has been successfully used as part of an enhanced recovery pathway in hip and knee replacement [49,50] and a recent meta-analysis of spinal surgery studies concludes that the use of tranexamic acid appears to be effective in reducing blood loss, the volume of blood transfusion, the transfusion rate and the post-operative partial thromboplastic time [48].…”

“…Tranexamic acid has been successfully used as part of an enhanced recovery pathway in hip and knee replacement [49,50] and a recent meta-analysis of spinal surgery studies concludes that the use of tranexamic acid appears to be effective in reducing blood loss, the volume of blood transfusion, the transfusion rate and the post-operative partial thromboplastic time [48]. Preoperative autologous blood donation in elective major spine surgery has also been seen to be effective for reducing allogeneic transfusion in elective major spine surgery, although inclusion in the programme can increase the risk of being transfused [51,52].…”